The Friends of St Nicholas Church
MEMBERSHIP APPLICATION
Please return to Christabel Ames-Lewis, Membership Secretary, 52, Prebend Gardens, London W6 0XU
c.ames-lewis@talktalk.net
Name
__________________________________________________________________
Address
__________________________________________________________________
__________________________________ Postcode ________________________
I enclose a cheque for £ __________ payable to ‘The Friends of St Nicholas Church’.
The annual membership donation is £25 minimum (£40 for a household): if you can give more this will
be warmly welcomed.
MAKING THE MOST OF YOUR DONATION TO THE FRIENDS
UK taxpayers can increase the value to the Friends of their annual donation by 25%, at no extra cost to
themselves, when they sign this Gift Aid Declaration:
I declare that I want the Friends of St Nicholas Church, registered charity 291262, to treat the enclosed
gift of £ _________________________________ (and all future gifts) as a Gift Aid donation.
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6
April to 5 April) that is at least equal to the amount of tax that all the charities (including churches) and
Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year.
I understand that other taxes such as VAT and Council Tax do not qualify.
I understand the charity will reclaim 25p of tax on every £1 that I have given.
Title:
______
Full name :
____________________________________________________________________
Address:
_______________________________________________
_______________________________________________ Postcode: _________________________________
Signature:
__________________________________________________________Date: ___________________________
PAYING BY BANKERS ORDER
Paying your annual membership donation by Banker’s Order simplifies the process of renewing your
membership both for you and for the Friends.
To:
_______________________________________________ Bank plc
Bank address: _____________________________________________________________________
Sort Code:
______________________ Account no: ____________________________________
Please pay to: HSBC, 281 Chiswick High Road W4 4HU
Sort Code:
40-02-13
For the credit of: The Friends of St Nicholas Church; Account No. 71181106
The sum of £ ____________________Amount in words ___________________________________
Starting on _________________________ and on the same date each month/quarter/year until you
receive further notice from me in writing. This instruction cancels any previous order in favour of the
Friends of St Nicholas Church.
Signature ________________________________________________Date ___________________
The Friends of St Nicholas Church
MEMBERSHIP APPLICATION